LIC 701 (1/98) (Confidential) have Physician: Address ...Risk factors present; Mantoux TB skin test...

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Transcript of LIC 701 (1/98) (Confidential) have Physician: Address ...Risk factors present; Mantoux TB skin test...

Page 1: LIC 701 (1/98) (Confidential) have Physician: Address ...Risk factors present; Mantoux TB skin test performed (unless previous positive skin test documented). Communicable TB disease